Disturbance of the intestinal biocenosis. Causes of disturbances of intestinal biocenosis

A biocenosis is a collection certain types bacteria that live on the skin or mucous membranes of humans. One such accumulation of microorganisms is the woman’s vagina.

In the microbiocenosis of the vagina, a certain ratio of different types of bacteria is important, since a decrease in some of them immediately leads to an increase in others, which can negatively affect a woman’s health. The vagina is the organ in which the largest number of types of microorganisms is noted. The composition of the biocenosis includes (not necessarily all of the following):

Lacto and bifidum bacteria;
Peptostreptococci;
Clostridia (may be, but rare);
Various representatives of gram-positive flora;
Rod-shaped and coccoid forms of gram-negative bacteria;

The number of certain bacteria can be used to judge a woman’s reproductive health. However, in different age categories there are certain differences in the composition of the vaginal microflora.

Biocenosis in children

In the prenatal period and in the first hours after birth, there is no flora in the girl’s vagina at all, which is due to the action of the mother’s immune system, which is partially transmitted to the child. Also, the absence of bacteria is associated with a mucous barrier, which ceases to function approximately in 4 hours after birth. But the vaginal membranes actively produce glycogen, which is an ideal nutrient medium for lactic acid bacteria, which include lactobacilli and bifidum bacteria. Colonization by opportunistic strains occurs after protective forces mothers cease to act in the child’s body, which corresponds to the third week of life. In general, before the onset of puberty, the bacterial ratio in the vagina of girls is unstable, and the hymen is the main protective factor.

Microflora in adolescents

During puberty, there is an active production of sex hormones, which contribute to the production of lactic acid bacteria, which makes it possible to relatively stabilize the vaginal biocenosis. Quantity conditionally pathogenic flora reduced, which is also associated with abundant mucous discharge during puberty. There is also a small content of bacteroids, diphtheroids and sometimes staphylococci. By the age of 16 the girl fully develops a certain biocenosis, which persists throughout reproductive period life.

Biocenosis in adult women

In a healthy adult woman quantity various types The bacterial flora of the vagina can reach 40 items. Among them, the vast majority, that is, more than 95%, are lactic acid bacteria. The remaining 5%, and sometimes less, are opportunistic strains. Normally, a woman has a predominance of anaerobic microorganisms, since the vagina is an organ with limited access to oxygen. In addition to permanent bacteria, in particular lactobacilli, various transient species may appear and disappear in a woman, for example, non-pathogenic staphylococci or clostridia in small quantities.

Biocenosis after menopause

This period in a woman’s body is accompanied by many changes, each of which depends on the production of sex hormones, which is significantly reduced. A fall hormonal levels has a detrimental effect on the reproduction of lactobacilli, which is why they gradually decrease with age. Since these microorganisms are a kind of wall from opportunistic flora, when their numbers decrease, various staphylococci, candida, and other representatives begin to actively multiply. That is why in old age problems of vaginal dysbiosis, inflammatory processes in it and thrush often arise.

When studying the biocenosis of the vagina to determine its significance for the woman’s body, it was found that this niche of microorganisms is an indicator of the state of the woman’s reproductive system. When most inflammatory pathologies occur, there is a violation of the ratio of different types of bacteria. However, besides this vaginal microflora The following functions are attributed:

Enzyme formation;
Protection reproductive system from pathogenic strains;
Production and stimulation of the formation of vitamins;
Indicator of atrophic phenomena (vaginal atrophy in older people).

By determining the ratio of bacteria in the vagina, one can judge about inflammation of the organ, even if there is no clinical picture of pathology.

Diagnostics

Analysis of vaginal microbiocenosis is carried out by taking a smear followed by bacterial inoculation on nutrient media. If the material is collected correctly, you can be confident in the accuracy of the results. If pathological agents are detected or excessive proliferation of opportunistic microflora is detected, an antibiotic sensitivity test is immediately performed, which will be useful for further treatment.

The results obtained can be of four types:

Norm. A healthy woman has a predominant amount of lactobacilli, small inclusions of opportunistic flora and a complete absence specific pathogens, as well as signs of pathology, in particular, leukocyte or epithelial cells.
Intermediate state. This result does not yet indicate pathology, but makes us wary. The clinical picture in this case is completely absent, which may cause the woman to refuse treatment. There is a slight decrease in beneficial strains of bacteria in the smear, which causes an increase in percentage opportunistic flora. The presence of leukocytes, epithelial cells and other signs of the onset of the inflammatory process is also noted.
The phenomenon of dysbacteriosis. This condition is considered a pathological process in which women experience certain complaints that require attention. The smear reveals a significant decrease or complete absence of beneficial microorganisms, excessive proliferation of opportunistic bacteria, as well as many leukocytes, and so on.
Inflammatory process in the vagina. accompanied by a pronounced clinical picture corresponding to the predominant microorganism. If this is a representative of an opportunistic flora, then vaginitis is nonspecific; if pathogens of a sexually transmitted nature are detected in the smear, then the inflammation is considered specific.

"Instrument for taking a smear

Vaginal disorders

Pathological changes in the vaginal biocenosis are indicated when an excessive amount of opportunistic microflora is sown in the smear, which causes nonspecific inflammatory processes. The main etiological factors causing a shift in balance:

Various forms of hormonal disorders;
Abuse of hormonal contraceptives;
Frequent use of local forms of contraception;
Prolonged and unjustified use of anti bacterial preparations, especially local;
Abuse;
Promiscuous sexual activity;
Failure to comply with intimate hygiene rules;
Primary and secondary immunodeficiencies;
Chronic inflammatory processes in genitourinary system or intestines.

Very often, disruption of the normal biocenosis of the vagina occurs due to incorrectly selected antibiotic treatment or if the patient did not carefully follow all doctor's orders. basis correct use antibacterial agents is their combination with drugs that restore microflora.

The clinical picture of biocenosis disturbance includes the following symptoms:

With unpleasant smell(can be of different colors, mixed with pus, and sometimes even blood);
and after it;
Pain in the lower abdomen;
Sometimes its disturbances also occur, which indicates that the infection has spread to the urinary system.

In some cases, the clinical picture is sparse, and at times it is completely absent, however, if the balance of microorganisms is disturbed, treatment is still required, since this state can lead to unpleasant consequences, for example, to the activation of fungi of the genus Candida or excessive proliferation of the very unpleasant bacterium Gardnerella.

Treatment

Since ignoring the disturbed balance of microflora can cause serious illnesses, then when diagnosing problems, you should immediately begin to restore the vaginal biocenosis. Therapy should be carried out exclusively under the supervision of an experienced physician, and also in conjunction with the results of an antibiotic sensitivity test.

Treatment of microbial balance disorders in the vagina is carried out in two stages. First, antibacterial therapy is prescribed, which is aimed at destroying excessive amounts of conditionally pathogenic microorganisms. Herbal remedies can be a substitute or addition to antibacterial therapy, which should be used only after consultation with a doctor and his approval of this type of traditional medicine.

After this, the vagina is repopulated with beneficial lacto and bifidum bacteria, due to which relapses of the imbalance and, accordingly, the inflammatory process do not occur.

If a woman experiences menstrual irregularities, then gynecologist also prescribes appropriate treatment, which most often consists of taking hormonal drugs. The exception is those cases where health problems were caused by improper use. oral contraceptives, which just contain hormones.

With the right therapy and strict adherence to the doctor’s instructions, a woman can quickly and permanently solve problems with the vaginal biocenosis. To maintain the correct ratio of all bacterial fractions, it must increase the body’s immune forces, conduct a decent sex life, refuse self-medication.

Man and his environment form a single ecological system, which is in biological equilibrium with respect to macro- and microorganisms (MO). It is well known that normal microflora (normoflora, or microbiota) populating the human intestine is important for regulating the optimal level of metabolic processes in the body and creating high colonization resistance of the gastrointestinal tract (GIT) to opportunistic MOs. However, in recent years there has been a tendency towards a significant increase in the number of various pathological conditions accompanied by a violation of the microecological balance of the intestine, which requires appropriate pharmacological correction, which is often also called biotherapy. For the first time in a significant role normal microflora intestines in human life and maintaining his health was indicated in his works by the outstanding domestic scientist I.I. Mechnikov. He believed that a lactic acid diet helps reduce the number of pathogenic MOs, calling lactic acid products “longevity products.” It was I.I. Mechnikov was the first to propose maintaining normal intestinal microflora at an optimal level with the help of microorganisms and their metabolic products.

Biotherapies include terms such as “probiotics,” “prebiotics,” and “probiotic products.” Over the years, there have been several interpretations of the term “probiotic.” D.M. Lilly, R.J. Stillwell first used this term in 1965 to refer to the metabolites produced by some MOs to stimulate the growth of others. The term “probiotics” literally means “for life” (in relation to a living organism), in contrast to the term “antibiotics” - “against life”. R. Parker proposed the term “probiotics” to denote natural adjuvants - living microorganisms, the introduction of which into the macroorganism helps maintain and restore the biological balance of its normal flora and has a positive effect on it. R. Fuller used the term “probiotics” to mean living MOs, which, when introduced into animal feed or human food (yogurt), have a positive effect on the body by improving the intestinal microflora. G.R. Gibson, M.B. Robefroid called probiotics live MO (for example, strains of live bacteria in yogurt), which must be present in products in sufficiently large quantities, remain stable and viable both during storage and after administration to the body; adapt to the host’s body and have a beneficial effect on its health. These same authors first proposed to introduce, along with the term “probiotics,” the term “prebiotics.” Unlike probiotics, prebiotics are substances or dietary ingredients that selectively stimulate the growth and biological activity of microorganisms in the intestine, positively affecting the composition of the microbiocenosis. In this article, we will focus on the characteristics of probiotic preparations only.

The total number of MOs living in various biotopes of the human body reaches a value of about 1015, i.e. the number of microbial cells is approximately two orders of magnitude greater than the number of the macroorganism’s own cells. The most significant part (about 60%) of the microflora populates various parts of the gastrointestinal tract, approximately 15-16% in the oropharynx. The urogenital tract, excluding the vaginal section (9%), is rather poorly populated (2%). The rest of the MO falls on skin. The digestive canal contains more than 500 different types of MO with a biomass of 2.5-3 kg. Together, the macroorganism and microflora constitute a single ecological system, which is in a state of homeostasis, or eubiosis. The most important among the representatives of microflora are lactobacilli (Lactobacillus acidophilus) and bifidumbacteria (Bifidumbacterium bifidum), which form the basis of the obligate (indigenous) flora. This group also includes bacteroides, clostridia, enterococci and Escherichia coli. The species composition of these MOs in humans is genetically determined, and their content in the intestine is relatively constant. At birth, a person does not have Lactobacillus acidophilus in the intestines, but later colonization and fast growth these MO. Bifidumbacterium bifidum is the first to be found in breastfed newborns, entering the sterile intestine with breast milk; later, other bacteria (L. casei, L. fermentum, L. salivares, L. brevis) begin to populate the newborn’s intestines as a result of its contact with the environment environment. Unlike obligate, the composition of facultative intestinal microflora changes depending on the action of certain factors external environment. This facultative microflora is represented by opportunistic MOs: staphylococci, streptococci, clostridia, Proteus, yeast-like fungi, etc. The composition of the microflora of different gastrointestinal biotopes and the content of various MOs in the feces of healthy adults are shown in Tables 1 and 2.

Violation of eubiosis is designated by the term “dysbiosis” or “dysbacteriosis” (the latter was first introduced by A. Nissle in 1916). In the CIS countries, the term “intestinal dysbiosis” is widely used in the literature; such a diagnosis is established based on the results of a study of the microflora of the colon. In foreign literature, the term “bacterial overgrowth syndrome” (SIBO) is used to refer to disturbances in the composition of intestinal microflora, which includes changes in the quantitative and species composition of microorganisms characteristic of a particular biotope. The main difference between the concepts of “SIBO” and “intestinal dysbiosis” lies not so much in terminological nuances, but in the content that goes into them. With SIBO, we are talking about a change not in the “microbial landscape” of the large intestine, but in the composition of the microflora of the small intestine. Causes of SIBO include decreased gastric secretion, dysfunction or resection of the ileocecal valve, intestinal digestion and absorption disorders, impaired immunity, intestinal obstruction, consequences surgical interventions(adductor loop syndrome, enteroenteric anastomoses, structural damage intestinal wall).

Thus, the gastrointestinal tract is unevenly colonized by bacteria. The highest density of microbial contamination in the large intestine is about 400 different species. The total biomass of colon microbial cells is approximately 1.5 kg, which corresponds to 1011-1012 CFU/g contents (about 1/3 of the dry weight of feces). It is the large intestine, due to such a high contamination, that bears the largest functional load compared to other biotopes. The main (resident) flora of the colon is represented by bifidobacteria, bacteroides and lactobacilli, which make up up to 90% of the entire colon microbiota. These representatives belong to anaerobic MO. Resident microflora also includes fecal enterococcus and propionic acid bacteria, but their share in the total pool of microbial populations is insignificant. The accompanying (facultative) microflora is represented mainly by aerobic microorganisms: Escherichia, eubacteria, fusobacteria, various cocci - a total of about 10%. Less than 1% accounts for numerous representatives of residual microflora, including aerobes and anaerobes. In general, 90% of the intestinal microflora are anaerobic bacteria, the anaerobic/aerobic ratio is 10:1. Thus, the main representatives of the intestinal microflora are aerobic lactobacilli (L. acidophilus, L. plantarum, L. casei, L. fermentum, L. salivares, L. cellobiosus) and anaerobic bifidobacteria (B. bifidum, B. infantis, B. longum , B. adolescentis).

The main functions of intestinal microflora normally include:

Colonization resistance of the macroorganism (intermicrobial antagonism, inhibition of growth and development of pathogenic microorganisms, prevention of the spread of putrefactive bacteria from lower sections colon to the upper, maintaining an acidic pH, protecting the ecosystem of the mucous membranes from pathogenic MO);

Detoxification (inactivation of enterokinase and alkaline phosphatase, prevention of the synthesis of toxic amines, ammonia, phenol, sulfur, sulfur dioxide, cresol);

Enzymatic function (hydrolysis of metabolic products of proteins, lipids and carbohydrates);

Digestive function (increased physiological activity of the glands of the alimentary canal, increased enzyme activity, participation in conjugation and recycling of bile acids, metabolism fatty acids and bilirubin, monosaccharides and electrolytes);

Synthesis of amino acids (arginine, tryptophan, tyrosine, cysteine, lysine, etc.), vitamins (B, K, E, PP, H), volatile (short-chain) fatty acids, antioxidants (vitamin E, glutathione), bioamines (histamine, serotonin , piperidine, γ-aminobutyric acid), hormonally active substances (norepinephrine, steroids);

Antianemic function (improved absorption and assimilation of iron);

Antirachitic function (improving the absorption of calcium and calciferols);

Anti-atherosclerotic function (regulation of lipid levels, cholesterol);

Antimutagenic and anticarcinogenic activity (hydrolysis of carcinogens from the metabolic products of proteins, lipids, carbohydrates, deconjugation of bile and hydroxylation of fatty acids, inactivation of histamine, xenobiotics, procarcinogenic substances, etc.);

Immune function (induction of the synthesis of immunoglobulins, lysozyme, interferon, stimulation of the local immune system, regulation of nonspecific and specific cellular and humoral immunity).

Intestinal microflora can be normal only when physiological state macroorganism. However, the quantitative and qualitative composition of normal microflora, as well as its functions, can be easily disrupted, which leads to the development of dysbiosis, which is currently understood as quantitative and/or qualitative changes in the intestinal microbiocenosis, as well as the appearance of microorganisms in places not typical for their habitat. According to modern epidemiological studies, 90% of the world's population suffers from intestinal dysbiosis to one degree or another. It's connected with poor nutrition, stress, decreased immunological reactivity of the body, environmental and physico-chemical factors of the external environment, unjustified and uncontrolled use of medications that affect the microflora of the body. It has been established that after suffering an acute intestinal infection in the absence of adequate therapy, dysbiotic changes in the intestines persist for at least 2-3 years. Intestinal dysbiosis is especially common in children of the 1st year of life (70-80%) and newborns (80-100%). In children over 1 year of age, dysbiosis is detected in 60-70% of cases, in healthy children over 3 years of age - in 30-50%.

The following can be distinguished main factors in the development of dysbiosis:

A. Exogenous:

Industrial poisons;

Violation of sanitary and hygienic standards in everyday life and at work;

Ionizing radiation;

Climatic and geographical factors;

Surgical interventions on the gastrointestinal tract.

B. Endogenous:

Immune disorders;

Stressful conditions;

Non-infectious diseases of the gastrointestinal tract (pathology of the intestine and gallbladder, gastric ulcer, etc.);

Infectious diseases;

Diabetes;

Rheumatic diseases;

Starvation;

Poor nutrition;

Elderly and senile age;

Irrational use of medications.

In children, factors for the development of dysbiosis can also be:

Anatomical disorders;

Food allergies;

Errors in nutrition;

Antibacterial therapy (including rational).

Clinical manifestations of dysbiosis are varied and are largely determined by the degree of disruption of the normal intestinal biocenosis. In some patients, any manifestations of dysbacteriosis may be completely absent, but most often there are the following characteristic complaints:

Unstable stool (constipation, diarrhea, or their alternation);

Bloating and rumbling in the stomach;

Pain in the lower abdomen, decreasing after the passage of gas;

Nausea, belching, bitterness in the mouth.

In addition, as a result of long-term dysbacteriosis, a number of pathological conditions arise secondarily, namely:

Asthenoneurotic syndrome (caused by hypovitaminosis and intoxication);

Anemia;

Hypoproteinemia;

Osteomalacia;

Reducing body weight;

Hypovitaminosis (mainly for fat-soluble vitamins).

In young children with the development of dysbacteriosis, regurgitation, vomiting, a decrease in the rate of increase in body weight, anxiety, and sleep disturbances are observed. The stool may be copious, liquid or mushy, foamy, greenish, with a sour or putrid odor. Abdominal pain is paroxysmal in nature, appears 2-3 hours after eating and is accompanied by bloating and the urge to defecate. Clinically, there are four degrees of severity of disturbances in the “microbial landscape” of the intestine:

1st degree– compensated (latent) dysbacteriosis, characterized by a change in the quantitative composition of aerobic microorganisms with a normal ratio of bifidobacteria and lactobacilli. There are no clinical signs.

2nd degree– subcompensated (localized) dysbacteriosis, manifested along with a decrease in the qualitative and quantitative composition of Escherichia, a moderate decrease in the content of bifidobacteria with a simultaneous increase in the number of opportunistic MOs. At the same time, in the intestine there is a moderately pronounced inflammatory process(enteritis, colitis).

3rd degree– widespread dysbacteriosis, characterized by significant changes in the qualitative and quantitative composition of normal microflora. Clinically manifested by intestinal dysfunction varying degrees gravity.

4th degree– generalized (decompensated) dysbacteriosis, in which, along with a significant increase in the content coli There is an almost complete absence of bifidobacteria and a sharp decrease in the level of lactic acid bacteria. Clinically manifested by severe intestinal dysfunction, bacteremia, septic complications, dystrophic changes from the internal organs.

There are general and specific methods for assessing microbial ecology and colonization resistance: histochemical, morphological, molecular genetic methods for studying MO, combined methods biomaterial studies, stress tests, etc. (Table 3). However, these methods, available to large research institutions, cannot be used to their full extent in widespread laboratory practice. In this regard, the most common method for diagnosing the state of microbiocenosis (in particular, dysbacteriosis) in most cases remains routine bacteriological analysis stool, as well as polymerase chain reaction, chromatography-mass spectrometry and the study of microbial metabolites.

To possible clinical consequences dysbacteriosis include:

Digestive disorders (diarrhea or constipation, flatulence, abdominal pain, regurgitation, vomiting);

Pathology of the digestive canal;

Allergic dermatoses (pseudoallergy);

Secondary immunodeficiency states;

Worsening of the course of immune-dependent pathology ( bronchial asthma, chronic obstructive pulmonary diseases, etc.).

At present, it is quite obvious that, by its nature, intestinal dysbiosis is a secondary phenomenon that reflects the functional state of the gastrointestinal tract and biliary system in the process of interaction with the environment and in connection with other problems of the human body. Therefore, it cannot be considered as an independent disease.

However, dysbiosis can lead to the development of infectious and inflammatory lesions in various parts of the intestine, as well as maintain or aggravate pathological changes in the gastrointestinal tract. At the same time, the term “dysbacteriosis” refers purely to microbiological concepts, and it can be used as clinical diagnosis it is forbidden. Intestinal dysbiosis almost never occurs in isolation, so to correct it it is necessary to identify and eliminate the factors that provoke its development. Without this, probiotic therapy will be ineffective or even pointless. So, A.I. Parfenov et al., in order to correct dysbiotic intestinal disorders, recommend reducing excess colonization of the small intestine, restoring normal microflora and intestinal motility, and improving intestinal digestion.

All of the above clinical manifestations intestinal dysbiosis, as well as the serious consequences that this condition can lead to, dictate the urgent need to eliminate it. Currently, the following possible ways to correct dysbiosis are identified::

Treatment of gastrointestinal pathology;

Elimination of risk factors for the development of dysbacteriosis;

Prescription of bacteriotherapy (probiotics);

The use of immunocorrectors;

Use of oral bacterial vaccines;

Diet food;

Enterosorption.

The most important among the methods of correcting dysbiosis, according to most experts, is the use of probiotic preparations. Probiotics (eubiotics) are freeze-dried live weakened strains of normal intestinal microflora, which, after ingestion, populate it. Bacteria activated in the intestines produce acetic and lactic acids, creating an acidic environment that inhibits putrefactive and gas-forming microorganisms (clostridia, proteus, bacteroides), and also synthesize antibacterial substances that inhibit the division of various opportunistic bacteria and pathogens of intestinal infections (salmonella, shigella and etc.). However, probiotics are not prescribed as replacement therapy, but as a means of providing conditions for the restoration of normal microflora. Probiotics are used both for the treatment and prevention of dysbiosis, especially in children. Suppression of rotting and fermentation processes by probiotics eliminates flatulence and normalizes the processes of digestion and absorption in the intestines. Restoring normal microflora helps stimulate the body’s immune system, increases its resistance to infectious agents, and makes it possible to realize many other positive effects that normal microflora has on the body. Table 4 shows a comparative description of probiotics registered in Ukraine.

As can be seen from the data presented in Table 4, active principle bifido-containing drugs are live bifidobacteria that have antagonistic activity against a wide range of pathogenic and opportunistic MOs. Their main therapeutic purpose is to ensure rapid normalization of the intestinal microflora and urogenital tract. Therefore, bifido-containing drugs are used to normalize the microbiocenosis of the gastrointestinal tract, increase nonspecific resistance of the body, stimulate the functional activity of the digestive system, and for the prevention hospital infections in maternity hospitals and hospitals. These drugs are prescribed to children and adults for the treatment of acute intestinal infections (shigellosis, salmonellosis, staphylococcal enterocolitis, rotavirus infection, food toxic infection), as well as gastrointestinal diseases (peptic ulcers of the stomach and duodenum, pancreatitis, cholecystitis, chronic diseases of the liver and biliary tract), allergic diseases, pneumonia, bronchitis, accompanied by dysbacteriosis. These drugs are also prescribed for inflammatory diseases of the urogenital tract, in surgical patients with diseases of the intestines, liver, pancreas (in the pre- and postoperative period) in order to correct intestinal microbiocenosis. This group drugs are recommended during a course of antibacterial therapy, the use of glucocorticosteroids, non-steroidal anti-inflammatory drugs, radiation therapy, chemotherapy (in the treatment of patients with cancer pathology).

The active ingredient of lactose-containing preparations is live lactobacilli, which have a wide range of antagonistic activity due to the production of organic acids, lysozyme, hydrogen peroxide and various antibiotic substances. Lactobacilli synthesize various enzymes and vitamins that take part in digestion and have an immunomodulatory effect. It is advisable to prescribe these drugs to children and adults in the treatment of acute intestinal infections, chronic gastrointestinal diseases with severe dysbiotic phenomena, especially in case of lactoflora deficiency or if it is necessary to use these drugs in combination with antibiotics. Experience in recent years has shown that the use of lactose-containing drugs is highly effective in the treatment of patients with rotavirus gastroenteritis and other intestinal infections for which antibacterial therapy is unsuccessful.

The therapeutic effects of coli-containing drugs are due to the antagonistic activity of Escherichia coli against pathogenic and opportunistic pathogens, including Shigella, Salmonella, Proteus, etc. These drugs are used in the treatment of protracted and chronic dysentery, post-treatment of convalescents after acute intestinal infections, chronic colitis and enterocolitis of various etiologies, with intestinal dysbiosis occurring against the background of E. coli deficiency. However, taking into account the immunomodulatory and adjuvant effects of E. coli lipopolysaccharide, one should be careful when prescribing coli-containing drugs to patients with ulcerative colitis in the acute stage, in which stimulation of local gastrointestinal immunity is undesirable.

In view of the numerous positive effects of lacto- and bifid-containing microorganisms, it is most advisable to use complex preparations, containing several main components of normal flora. Linex is one of the most balanced probiotics, which includes live lyophilized bacteria from various parts of the intestine: Lactobacillus acidophilus, Bifidumbakterium infantis v. liberorum, Streptococcus faecium. These bacteria are representatives of the normal intestinal microflora, are resistant to antibiotics and other chemotherapeutic agents, and do not transfer this resistance to pathogenic strains of MO. Once in the intestine, the components of Linex perform all the functions of normal intestinal microflora: they reduce the pH of the intestinal contents, create unfavorable conditions for the reproduction and vital activity of pathogenic microorganisms, participate in the synthesis of vitamins B, PP, K, E, C, folic acid, create favorable conditions for the absorption of iron, calcium, zinc, cobalt, B vitamins. In addition, lactic acid bacteria in Linex colonize small intestine and carry out enzymatic breakdown of proteins, fats, complex carbohydrates, incl. with lactase deficiency in children. Proteins and carbohydrates that are not absorbed into small intestine, undergo deeper breakdown in the large intestine by anaerobes, in particular bifidobacteria, which are part of Linex. Bifidobacteria produce the enzyme phosphoprotein phosphatase, necessary for the metabolism of milk casein in infants, stabilize the membranes of intestinal epithelial cells, participate in the resorption of monosaccharides and regulate electrolyte balance in the intestine. Linex components are also involved in the metabolism of fatty acids and have hypocholesterolemic and antitoxic effects. In addition to the main probiotic effect, the combination of microorganisms that make up Linex also provides its pronounced bactericidal and antidiarrheal properties. Taking into account all of the above, we can say that Linex meets all modern requirements requirements for probiotics: it is of natural origin, creates an acidic environment in different biotopes of the gastrointestinal tract, thereby preventing the proliferation of putrefactive and pathogenic flora, normalizes intestinal motility, populates it with normal symbionts, is safe, has a clinically proven effect and is convenient for use. In recent years in clinical practice Considerable positive experience has been accumulated in the use of Linex in children and adults.

To prevent and treat dysbiosis, along with medicinal forms of probiotics, functional food products and dietary supplements are also used. This special forms probiotics, which are food products containing live probiotic strains of microorganisms intended for daily consumption and having a regulatory effect on physiological functions and biochemical reactions human body. Such dietary supplements include the Biofamily product line, which contains components of normal intestinal microflora, individually balanced for different age groups.

Probiotics are used mainly as prophylactics and concomitant therapy, but in the future, according to R. Walker and M. Buckley, it is possible to expand the indications for their use, which will include:

Biological therapy using antibiotic-sensitive bacteria to replace resistant microorganisms;

Preventing the translocation of pathogenic bacteria from the skin and mucous membranes into internal environment macroorganism;

Promoting faster weight gain;

Eradication of certain types of bacteria from the body (for example, Helicobacter pylori);

Restoring the composition of microflora after treatment with antibiotics;

Changing the composition of the intestinal microflora in accordance with the characteristics of the diet;

Improving oxalate metabolism to reduce the incidence of kidney and bladder stones;

Destruction of potentially hazardous chemicals;

Suppression of pathogenic tumors (S. aureus and Clostridium difficile) in hospital patients;

Prevention of bladder infections.

In conclusion, it is worth emphasizing that intestinal dysbiosis must be promptly diagnosed and treated, and even better, it must be prevented with the help of probiotic preparations and/or products. Doctors and patients today have a sufficient choice of means to preserve and maintain the balance of the normal microflora of the body. The general task is their rational and targeted use, taking into account the individual characteristics of the microbiocenosis of a particular macroorganism.

Probiotics versus antibiotics?

Experts say that in the 21st century, the fight against human illnesses, as well as their prevention, will come to the forefront microbiological methods. Therefore, the new concept of “Probiotics and functional nutrition”, developed at the end of the last century, according to the scientific world, is as significant an achievement of the 20th century as human space flight or the creation of computers.

Svetlana RUKHLIA

Functional nutrition is something that helps improve the functioning of all our organs and systems. Probiotics are living organisms that, when used in adequate quantities, have a health-improving effect on humans.

Poor nutrition and environmental disasters, uncontrolled use of antibiotics in medicine and agriculture, the use of preservatives, chlorination of water, stress and... the list goes on for a long time - lead to the occurrence of dysbacteriosis. According to Academician of the Russian Academy of Medical Sciences V. Pokrovsky, 90% of the Russian population suffers from this disease. Modification of the microflora reduces the body's defenses, causes digestive and metabolic disorders, and these, in turn, bring many serious ailments to a person, including diabetes and bronchial asthma.

According to the vice-president of the St. Petersburg branch of the Union of Pediatricians of Russia and the chief specialist in child nutrition of the Health Committee, Professor Elena Bulatova, “for normal life to the human body normal microflora is required, the basis of which is probiotic microorganisms, primarily bifidobacteria and lactobacilli. It has been scientifically proven that the use of probiotics is the most effective way to correct dysbiosis. IN Lately There have been many scientific studies on this topic in the world, and their results suggest that the “era of probiotics” is approaching, which should replace the “era of antibiotics.”

In the treatment of dysbiosis, sorbed probiotics, which are drugs of the latest (fourth) generation, are most effective. However, treatment, like diagnosis, should remain the prerogative of doctors, but the prevention of microflora disorders can (and should!) be done independently. Fortunately, today there are many functional food products that contain probiotics on city shelves. But it is important to understand that these products are not intended for a single massive course of “receiving useful substances", but for systematic daily use. From which it follows that their inclusion in the diet should become as natural a necessity as, say, brushing your teeth.

By the way, according to doctors, for a full life/survival, bacteria need an acidic environment - accordingly, our body receives them from sweet kefir and cottage cheese minimum quantity. However, to the delight of those with a sweet tooth, a product purchased in sour form can be sweetened independently, and if, without delaying the matter, it is consumed immediately, there will be no threat to the life and quality of bacteria.

ã Kopanev Yu.A., Sokolov A.L. Intestinal dysbiosis in children

Laboratory diagnosis of dysbiosis is most often based on microbiological analysis of feces. Microbiological criteria are the state of bifido- and lactoflora, a decrease in the number of Escherichia, the appearance of E. coli strains with altered properties, an increase in the number of cocci, the detection of opportunistic gram-negative bacilli, as well as fungi. Various combinations of microbiological shifts are possible in the analyses. However, there is no single point of view in assessing the degree of dysbiosis, since different clinical and laboratory criteria are often used.

When assessing intestinal microflora disorders, it is recommended to take into account the following indicators :

Quantitative indicator of violations of the anaerobic component (absence or reduction of bifidobacteria to 10 5 -10 7 in 1 g of feces);

Quantitative indicator of “disinhibition” of the aerobic component (increase in the number of UPF: Proteus, Klebsiella, lactose-negative enterobacteria, hemolyzing staphylococci) and/or the appearance or increase of fungi;

An indicator of changes in the quality of representatives of the aerobic flora (the appearance of lactose-negative and hemolyzing Escherichia coli, pathogenic staphylococcus, etc.);

The ratio of anaerobic and aerobic components of microflora.

A method for studying intestinal biocenosis proposed by R.V. Epstein-Litvak and F.L. Vilshanskaya, provides for determining the percentage of UPF in relation to the normal flora and has a greater clinical significance than a method where only bacterial dilutions are taken into account, since the ratio of opportunistic and normal flora can be clearly shown. Therefore, this method is recommended for determining disturbances in intestinal biocenosis.

According to this method, the following parameters in 1 g of feces are taken as standards: the total amount of E. coli with normal enzymatic activity is at least 300 million/g; E. coli with reduced enzymatic activity of no more than 10% of the total amount of E. coli; the presence of lactose-negative enterobacteria up to 5% of the total amount of E. coli; absence of hemolyzing Escherichia coli; the number of non-hemolyzing cocci (enterococci, epidermal staphylococcus, etc.) up to 25% of the total amount of microbes; absence of hemolyzing staphylococci ( S. aureus and etc.); the number of bifidobacteria 10 8 and higher; the number of lactobacilli is 10 6 and higher; absence of fungi of the genus Candida or their presence up to 10 4 .

There are various microbiological classifications. Here are the most famous ones.

Classification according to microbiological characteristics :

1st degree:anaerobic flora predominates over aerobic flora, bifidobacteria and lactobacilli are contained in a dilution of 10 8 -10 7 or one of these types of bacteria is found in a dilution of 10 9 -10 10. UPF (no more than two types) is determined in dilutions of no more than 10 4 -10 2.

2nd degree:anaerobic flora is suppressed, its quantity is equal to aerobic flora, full-fledged E. coli is replaced by its atypical variants (lactose-negative, hemolyzing). UPF is found in associations, with the degree of dilution reaching 10 6 -10 7 .

3rd degree:aerobic flora predominates, bifidobacteria and lactobacilli are absent in feces or their number is sharply reduced. Significantly increases specific gravity UPF, its spectrum is expanding significantly.

“Unified working classification of intestinal biocenosis disorders in young children” according to I.B. Kuvaeva and K.S. Ladodo (1991):

First degree- latent phase. It manifests itself in a reduction by 1-2 orders of magnitude in the amount of normal flora - bifidobacteria, lactobacilli, as well as full-fledged E. coli by no more than 20%. The presence of UPF in an amount of no more than 10 3. The remaining indicators correspond to the physiological norm (eubiosis). As a rule, the initial phase does not cause intestinal dysfunction and occurs as a reaction of the body of a practically healthy person to the influence of unfavorable factors. In this phase, a small amount of individual UPF representatives may grow in the intestines.

Second degree- the starting phase of more serious violations. It is characterized by a pronounced deficiency of bifidobacteria (10 7 or less), an imbalance in the quantity and quality of E. coli, among which the proportion of lactose-negative ones is increasing. Against the backdrop of shortage protective components intestinal biocenosis, UPF (staphylococci, fungi of the genus Candida , lactose-negative enterobacteria).

Third degree- phase of disinhibition and aggression of aerobic flora. It is characterized by a clear increase in the content of aggressive microorganisms, replacement of full-fledged Escherichia (their number decreases to 50% or less) by bacteria of the genera Klebsiella, Enterobacter, Citrobacter, etc. Associations of 2-3 representatives of UPF are identified in dilutions of up to 10 5 -10 6.

Fourth degree - phase of associative dysbacteriosis. Characterized by a deep imbalance of the intestinal biocenosis with a change in the quantitative ratios of the main groups of microorganisms, a change in their biological properties, accumulation of toxic metabolites. There is a significant decrease in normal flora and its functional activity.

Unfortunately, existing microbiological classifications are not always applicable in practice, since the doctor often has to deal with microbiological abnormalities that do not correspond to any of the degrees of the known classifications. The lack of a unified approach to the problem of dysbiosis not only creates diagnostic difficulties, giving rise to over- and under-diagnosis, but also does not allow the implementation of appropriate treatment in full.

For ease of interpretation of the results of the study of biocenosis, we offer a working grouping of microbiological abnormalities in the intestines by type and degree (see Appendix 4). Depending on the nature of disturbances in the biocenosis, two types of intestinal dysbiosis can be distinguished, and in each type the degrees of microbiological deviations are distinguished.

Dysbacteriosis type I characterized by a decrease in normal flora in the absence of increased growth of the UPF.

1st degree- reduction in the total amount of E. coli with normal enzymatic activity; possible increase the amount of E. coli with reduced enzymatic activity of more than 10% against the background of normal or slightly reduced (no more than one order of magnitude) amount of bifidobacteria and lactobacilli;

2nd degree- a decrease in the number of lactobacilli by 2 orders of magnitude (10 5 or less) against the background of a normal or slightly reduced number of bifidobacteria, any (including reduced) amount of E. coli with normal enzymatic activity;

3rd degree- a significant decrease in bifidobacteria (10 7 or less) against the background of any number of lactobacilli and E. coli.

It is possible to identify 4 degrees of dysbacteriosis I type in which all three types of normal flora are sharply reduced.

Dysbacteriosis type II characterized by an increased presence of UPF in the intestine against the background of a normal or slightly reduced amount of normal flora.

1st degree -an increase in the total amount of UPF to 10% (or the presence of one type of UPF in quantities up to 10 6 inclusive);

2nd degree -an increase in the total amount of UPF from 11 to 50% (or the presence of several types of UPF in quantities up to 10 6 inclusive of each);

3rd degree -an increase in the total amount of UPF from 51% or higher (or the presence of any type of UPF in an amount of 10 7 or more).

In this case, there may be any amount of saprophytic flora (non-hemolyzing cocci).

If the total amount of UPF is 100%, we can talk about 4 degrees of dysbiosis Type II.

The release of UPF in the absence of changes on the part of the indigenous flora may be transient in nature, indicate the persistence of microbes, or be etiological factor for gastrointestinal diseases.

With combined dysbiosis, the degree of microbiological abnormalities is determined by the higher degree of dysbiosis of one of the types. Thus, if a child has deviations in intestinal biocenosis corresponding to 1st degree of dysbiosis I type and 3 degrees of dysbacteriosis II type, then the overall degree of intestinal dysbiosis will correspond to degree 3. There is no need to distinguish the combined type of dysbacteriosis. In this case, in the described example, the bacteriological diagnosis will sound: intestinal dysbiosis I type 1 degree in combination with intestinal dysbiosis II type 3 degrees.

The proposed grouping can be used when choosing a treatment algorithm. We consider the identification of types of dysbiosis to be a fundamental point, since the tactics of corrective measures, depending on the type of dysbiosis, differ significantly.

In some cases, microbiological examination of feces does not reveal any abnormalities other than an increase in the number of non-fermentative bacteria (most often in the form of an increase in the percentage of Escherichia coli with weakly expressed enzymatic properties). This may indicate latent dysbiosis: formally the amount of indigenous flora is not disturbed, but in fact the normal flora does not fulfill its functions, so clinical manifestations may be typical for dysbiosis Type I

Seasonal changes in microflora in children

In order to study seasonal fluctuations in the intestinal microflora, the results of a study of feces over two calendar years were analyzed in 1500 children aged 1 to 12 months, as well as in children aged 1 to 5 years and from 5 to 14 years (700 people per group ). We do not claim high statistical reliability for each month, since the monthly groups consisted of 50-100 people. Fluctuations were measured from the norm limits for normal flora - 10 8, and clinically significant amount UPF - 10 5. These studies helped identify some seasonal trends.

It has been observed that over the course of a calendar year, the frequency of occurrence of each microorganism can undergo significant changes. Thus, during the first year of the study, in the group of children under 1 year of age, hemolyzing E. coli was detected much more often in July than in January (67 and 25% of all cultures submitted during this period, respectively). Similar fluctuations throughout the year were noted for other representatives of the intestinal microflora.

After the second year of the study, when analyzing graphs of the frequency of occurrence of bacteria, trends in changes in the composition of intestinal microflora depending on the season were identified. For some microorganisms, especially opportunistic ones, there are fluctuations in abundance and occurrence in the analysis depending on the time of year. Moreover, the more pathogenic the microbe, the more pronounced the dependence on the season is revealed with minimal fluctuations throughout the year (Staphylococcus aureus), which indirectly corresponds to the known seasonal fluctuations of intestinal infections (rotavirus, salmonellosis, dysentery).

Fluctuations in the number of microorganisms in the intestines depending on the time of year are different in different ages for some microbes and the same for others (fungi of the genus Candida, E. coli).

The UPF has synchronous fluctuations from year to year in numbers and occurrence, and the normal flora, as a rule, does not undergo synchronous seasonal fluctuations, or they are insignificant.

The following patterns have been identified in different age groups.

In the group from 0 to 1 year

1. Hemolyzing E. coli is found in tests 20-25% more often in summer than in other seasons.

2. Lactose-negative enterobacteria of the genus Klebsiella have a series of peaks and valleys. Peaks of occurrence are March, June, September, December. Recessions - April-May, August, October. At the same time, greater detection is observed in summer, autumn and early winter and less - from January to May.

3. Lactose-negative enterobacteria of the genus Proteus (vulgaris, morgani, mirabilis). Synchronous clear peaks in the increase in the number of Proteus in crops are observed in January, April, and November. Recessions - in February-March, June-October.

4. Bifidobacteria are found in 10 8 throughout the year in 70-100% of children. Some decline is observed in August (10-50%).

5. Hemolyzing Staphylococcus aureus, the most pathogenic of all microorganisms studied, had pronounced seasonal fluctuations. During the year, its occurrence is noted at the background level in 1-7% of studies; in January, the occurrence increases to 19%.

6. Escherichia coli with normal enzymatic activity has an October-January decline and a June rise. Those. a smooth increase in winter and spring and a smooth decline by late autumn.

In the group from 1 to 5 years

1. Hemolyzing E. coli slowly increases from 15-25 to 30-47% from January to November. In December there is a decline.

2. The occurrence of Klebsiella slowly increases from 1-5 to 30-37% in the period from February to August-September. A similar decline is observed in October-January.

3. The occurrence of microorganisms of the genus Proteus (vulgaris, morgani, mirabilis) slowly increases from 1 to 13% from spring to autumn, with a decline observed in winter.

4. The occurrence of E. coli with normal enzymatic activity has a May-June peak and a decline in July-August and November-December. At the same time, the autumn peak is less than the May one. Those. there is a tendency for the amount of E. coli to increase in the spring and decrease in the fall. Perhaps this can indirectly be explained by helminthic infestations.

In the group from 5 to 14 years old

1. The occurrence of Klebsiella increases by August to 16% and by the beginning of January - to 15-20%. The greatest decline is observed in early spring and late autumn.

2. Bifidobacteria are detected at 10 8 throughout the year in 60-100% of children, but there is a decline in July-August by 10-30%.

3. Hemolyzing Staphylococcus aureus. Synchronous annual increase in detections in November with a very low number of detections throughout the year.

4. Escherichia coli with normal enzymatic activity: there is a decline in the total number and occurrence in the fall from October to December.

5. Lactobacilli are found in the eighth dilution throughout the year in 20-90% of children, there is a small peak in August.

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Classification of disorders of intestinal biocenosis

ã Kopanev Yu.A., Sokolov A.L. Intestinal dysbiosis in children

Laboratory diagnosis of dysbiosis is most often based on microbiological analysis of feces. Microbiological criteria are the state of bifido- and lactoflora, a decrease in the number of Escherichia, the appearance of E. coli strains with altered properties, an increase in the number of cocci, the detection of opportunistic gram-negative bacilli, as well as fungi. In analyzes it is possible various combinations microbiological changes. However, there is no single point of view in assessing the degree of dysbiosis, since different clinical and laboratory criteria are often used.

When assessing intestinal microflora disorders, it is recommended to take into account the following indicators:

— a quantitative indicator of violations of the anaerobic component (absence or reduction of bifidobacteria to 10 5 -10 7 in 1 g of feces);

— a quantitative indicator of “disinhibition” of the aerobic component (increase in the number of UPF: Proteus, Klebsiella, lactose-negative enterobacteria, hemolyzing staphylococci) and/or the appearance or increase of fungi;

— an indicator of changes in the quality of representatives of the aerobic flora (the appearance of lactose-negative and hemolyzing Escherichia coli, pathogenic staphylococcus, etc.);

— the ratio of anaerobic and aerobic components of microflora.

A method for studying intestinal biocenosis proposed by R.V. Epstein-Litvak and F.L. Vilshanskaya, involves determining the percentage of UPF in relation to normal flora and has greater clinical significance than the method where only bacterial dilutions are taken into account, since the ratio of opportunistic and normal flora can be clearly shown. Therefore, this method is recommended for determining disturbances in intestinal biocenosis.

According to this method, the following parameters in 1 g of feces are taken as standards: the total amount of E. coli with normal enzymatic activity is at least 300 million/g; E. coli with reduced enzymatic activity of no more than 10% of the total amount of E. coli; the presence of lactose-negative enterobacteria up to 5% of the total amount of E. coli; absence of hemolyzing Escherichia coli; the number of non-hemolyzing cocci (enterococci, epidermal staphylococcus, etc.) up to 25% of the total amount of microbes; absence of hemolyzing staphylococci (S. aureus, etc.); the number of bifidobacteria 10 8 and higher; the number of lactobacilli is 10 6 and higher; absence of fungi of the genus Candida or their presence up to 10 4.

There are various microbiological classifications. Here are the most famous ones.

Classification according to microbiological characteristics :

1st degree: anaerobic flora predominates over aerobic flora, bifidobacteria and lactobacilli are contained in a dilution of 10 8 -10 7 or one of these types of bacteria is found in a dilution of 10 9 -10 10. UPF (no more than two types) is determined in dilutions of no more than 10 4 -10 2.

2nd degree: anaerobic flora is suppressed, its quantity is equal to aerobic flora, full-fledged E. coli is replaced by its atypical variants (lactose-negative, hemolyzing). UPF is found in associations, with the degree of dilution reaching 10 6 -10 7 .

3rd degree: aerobic flora predominates, bifidobacteria and lactobacilli are absent in feces or their number is sharply reduced. The share of UPF increases significantly, its spectrum expands significantly.

“Unified working classification of intestinal biocenosis disorders in young children” according to I.B. Kuvaeva and K.S. Ladodo (1991):

First degree- latent phase. It manifests itself in a decrease by 1-2 orders of magnitude in the amount of normal flora - bifidobacteria, lactobacilli, as well as full-fledged E. coli by no more than 20%. The presence of UPF in an amount of no more than 10 3. The remaining indicators correspond to the physiological norm (eubiosis). As a rule, the initial phase does not cause intestinal dysfunction and occurs as a reaction of the body of a practically healthy person to the influence of unfavorable factors. In this phase, a small amount of vegetation may grow in the intestines. individual representatives UPF.

Second degree— the starting phase of more serious violations. It is characterized by a pronounced deficiency of bifidobacteria (10 7 or less), an imbalance in the quantity and quality of E. coli, among which the proportion of lactose-negative ones is increasing. Against the background of a deficiency of protective components of the intestinal biocenosis, UPF (staphylococci, fungi of the genus Candida, lactose-negative enterobacteria) multiply.

Fourth degree— phase of associative dysbacteriosis. It is characterized by a deep imbalance of the intestinal biocenosis with a change in the quantitative ratios of the main groups of microorganisms, a change in their biological properties, and the accumulation of toxic metabolites. There is a significant decrease in normal flora and its functional activity.

Dysbacteriosis type I characterized by a decrease in normal flora in the absence of increased growth of the UPF.

1st degree- reduction in the total amount of E. coli with normal enzymatic activity; a possible increase in the amount of E. coli with reduced enzymatic activity of more than 10% against the background of a normal or slightly reduced (no more than one order of magnitude) amount of bifidobacteria and lactobacilli;

3rd degree- a significant decrease in bifidobacteria (10 7 or less) against the background of any number of lactobacilli and E. coli.

It is possible to distinguish the 4th degree of type I dysbiosis, in which all three types of normal flora are sharply reduced.

Dysbacteriosis type II characterized by an increased presence of UPF in the intestine against the background of a normal or slightly reduced amount of normal flora.

1st degree - an increase in the total amount of UPF to 10% (or the presence of one type of UPF in quantities up to 10 6 inclusive);

2nd degree - an increase in the total amount of UPF from 11 to 50% (or the presence of several types of UPF in quantities up to 10 6 inclusive of each);

3rd degree - an increase in the total amount of UPF from 51% or higher (or the presence of any type of UPF in an amount of 10 7 or more).

In this case, there may be any amount of saprophytic flora (non-hemolyzing cocci).

If the total amount of UPF is 100%, we can talk about 4 degrees of type II dysbiosis.

The release of UPF in the absence of changes in the indigenous flora may be transient in nature, indicate the persistence of microbes, or be an etiological factor in gastrointestinal diseases.

With combined dysbiosis, the degree of microbiological abnormalities is determined by the higher degree of dysbiosis of one of the types. Thus, if a child has deviations in intestinal biocenosis corresponding to degree 1 of type I dysbiosis and degree 3 of type II dysbiosis, then the overall degree of intestinal dysbiosis will correspond to degree 3. There is no need to distinguish the combined type of dysbacteriosis. In this case, in the described example, the bacteriological diagnosis will be: intestinal dysbiosis type I, degree 1, combined with intestinal dysbiosis type II, degree 3.

Disturbance of intestinal microbiocenosis in children

"Local pediatrician", 2011, No. 5, p. 10-11

Interview with a researcher at the scientific advisory department of the clinic of the Research Institute of Nutrition of the Russian Academy of Medical Sciences, Candidate of Medical Sciences Natalia Nikolaevna Taran

Natalia Nikolaevna, the term “dysbacteriosis” is very ambiguous. There is no such disease in either foreign or Russian classifications of diseases. Nevertheless, you can constantly hear it from doctors and parents. Please explain what it is - intestinal dysbiosis.

— Indeed, this condition is not an independent disease or nosological entity. During the life of a person, in particular a child, various external and internal factors can cause changes in the intestinal microbiocenosis, but in most cases these deviations are transient and do not require correction. In the body of an adult, microflora quantitatively accounts for 2-3 kg of body weight! And intestinal dysbiosis is a persistent qualitative and quantitative deviation in the composition of the intestinal microflora. It is necessary to know and remember that dysbiosis is always secondary.

What circumstances can cause disturbances in intestinal microflora?

— There are quite a lot of these reasons, they differ somewhat in different age groups. Thus, in infants and young children, the qualitative and quantitative composition of the microflora can be influenced by pathological course pregnancy, childbirth caesarean section, late breastfeeding, early artificial feeding, frequent respiratory and intestinal infections, food allergy, use of antibacterial agents. In older children, in addition to those already listed, factors such as unbalanced diet, chronic diseases digestive tract, stress, immunodeficiency conditions, etc.

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Often the reason for taking a test for dysbiosis is minor deviations in the child’s health. Natalia Nikolaevna, please list those situations when this analysis can really be shown.

— The following situations may be the basis for a doctor’s recommendation to conduct this study in addition to the main examination:

long-term intestinal disorders that cannot be corrected;
unstable stool (from diarrhea to constipation);
the presence of mucus, blood, pieces of undigested food in the stool, uneven coloring;
atopic dermatitis with elements of secondary infection;
frequent acute respiratory viral infections;
antibacterial therapy;
drug therapy with hormones and immunosuppressants;
long hospital stay.

Natalia Nikolaevna, how should we approach the interpretation of the results obtained?

— On the one hand, there is a classification of dysbacteriosis, which takes into account the number and ratio of “beneficial” (lacto-, bifido-) bacteria, E. coli, and opportunistic microorganisms. Normally, the content of bifidobacteria should be at least 10 9 -10 10, lactobacilli -10 6 - 10 8 live microbial bodies per 1 g of feces, and E. coli should be approximately 0.01% of total number dominant bifidobacteria and lactobacilli. The optional part of the normal microflora (staphylococcus aureus and epidermal, bacteria of the Enterobacteriaceae family - Proteus, Klebsiella, Clostridia, Enterobacter; some types of yeast fungi) should constitute no more than 0.6% of the total number of microorganisms.

1st degree Dysbacteriosis is characterized by a decrease in the number of bifidobacteria and/or lactobacilli to a level of less than 10 6 CFU/g of feces and an increase in the number of Escherichia coli to more than 10 8 CFU/g of feces.

At 2nd degree— one type of opportunistic microorganisms 10 5 CFU/g feces and associations of opportunistic microorganisms 10 3 -10 4 CFU/g feces are identified.

3rd degree— identification of one type of opportunistic microorganisms or associations in high titers.

On the other hand, the interpretation of microbiological analysis of stool and, accordingly, the need for its correction should be approached with great caution and practical conclusions should be drawn only after comparing the analysis data with clinical picture and complaints from the patient or his parents.

What else should a pediatrician take into account when deciding on the treatment of intestinal microbiocenosis disorders?

— It is important to understand that with dysbiosis, normal intestinal flora does not die, only its quantity and ratio with opportunistic microorganisms decrease, and the environment of the chyme of the large intestine becomes alkalized. Uncontrolled use of antibacterial drugs, phages, probiotics for the treatment of dysbiosis can lead to the opposite result - aggravation of existing changes. This is especially true for young children.

What would you recommend to use to correct dysbiosis in a child?

— Firstly, for infants the most effective preventive and therapeutic “remedy” is breast milk. It contains substances that stimulate the growth of beneficial bacteria in the intestines, as well as bifidobacteria and lactobacilli themselves. This contributes to a more efficient and high-quality formation of microbiocenosis and is fundamental for the development and formation of the child’s immune system. In some cases, in young children, breastfeeding will be sufficient to successfully resolve temporary problems.

Secondly, treatment of dysbiosis should always be comprehensive, taking into account the underlying disease and predisposing factors, the nature of the symptoms and the depth of the disorders, and also be carried out under the supervision of a doctor.

To treat dysbiosis, pro- and prebiotics are most actively used. Probiotics are preparations containing live bacteria, representatives of the normal human intestinal microflora. Prebiotics, unlike probiotics, do not contain living bacteria, but at the same time they have the ability to favorably influence the state of microbiocenosis, improving the vital activity of beneficial bacteria and creating the maximum possible comfortable conditions. In some cases, the use of a prebiotic is sufficient to restore the harmonious balance of microflora.

Natalia Nikolaevna, what prebiotic could you recommend for use in children of different age groups?

— One of the drugs with prebiotic properties is Hilak forte. Hilak forte contains an optimized set of products of metabolic activity of strains of lactobacilli and normal intestinal microorganisms, as well as dairy and phosphoric acid, amino acids. Biological activity 1 ml of Hilak forte corresponds to the activity of approximately 100 billion (10 10 -10 11) living microorganisms.

This combined drug, unique in its composition and functions, is used in pediatric practice from birth (including in premature infants). After oral administration, it acts only in the intestinal lumen, is not absorbed into the blood and is excreted from the digestive tract with feces.

V complex therapy when caring for premature newborns both in the hospital and during the first 12 months of life:
babies with unstable stools;
bottle-fed infants. Hilak forte helps soften the consistency of stool, normalizes intestinal motility, disrupts the growth of putrefactive microflora;
children of the first year of life with severe disturbances of peristalsis, dysfunctional disorders of the gastrointestinal tract (GIT) - regurgitation and intestinal colic;
children and adults from the first day of antibacterial therapy, acute intestinal infections, with chronic diseases Gastrointestinal tract, which are accompanied by an imbalance of intestinal microflora;
for functional constipation.

The positive effect of the drug Hilak Forte as part of complex therapy for acute respiratory viral infections was also noted.

How is Hilak forte prescribed?

— Hilak forte is prescribed for infants 15-30 drops, for children 20-40 drops, for adults 40-60 drops 3 times a day. After the condition improves, the initial dose of the drug can be reduced by half. Take orally before or during meals in a small amount of liquid other than milk.

Available in convenient dosage form, which provides ease of dosing depending on the age of the child.

Natalia Nikolaevna, thank you for the conversation!

The intestines of a healthy person are populated by many different microorganisms, without which normal life activity is impossible. Digestive problems that children in the first year of life may encounter are often associated with a violation of the normal ratio between the bacteria inhabiting the intestines. Many parents remember how common the diagnosis of “intestinal dysbiosis” was in the recent past. However, at present, pediatricians treat this diagnosis with doubt - firstly, because it does not quite legitimately combine the causes for various reasons(and, accordingly, requiring different treatment) pathological conditions, and secondly, because quite often dysbiosis itself is not a disease (about 15% of children in the first year of life who have significant deviations from the norm in the composition of the intestinal microflora are completely healthy).
Recently, doctors are increasingly talking not about dysbiosis, but about disorders of the intestinal biocenosis. Intestinal biocenosis- this is the quantitative and qualitative composition of its microflora, that is, the microorganisms inhabiting it. And before we move on to talking about disorders of the intestinal biocenosis itself, it is probably worth talking about what it should be like normally: what bacteria inhabit the intestines, what is the quantitative relationship between them, what functions do they perform. Let's start with how microorganisms generally get into the human intestines.

SETTLEMENT OF THE CHILD'S GUT WITH MICROFLORA

Before birth. The intestines of the fetus and the original feces formed in it - meconium - are normally sterile, that is, they do not contain microorganisms. However, if the mother has inflammatory diseases of the genitourinary tract, microbes can enter the amniotic fluid and from there into the child’s gastrointestinal tract. This usually happens 3-4 days before birth, when the membranes of the fetus become thinner and become permeable to various microorganisms. A condition characterized by the presence of microorganisms in the amniotic fluid is called infected amniotic fluid syndrome.
Childbirth. During childbirth, the baby's first encounter with microorganisms occurs. Passing through the tight fitting ones birth canal, the child involuntarily “licks” their surface, thus the normal microflora of the mucous membrane of the mother’s genital tract enters his gastrointestinal tract. However, if a woman suffers from infectious and inflammatory diseases of the genital area, a wide variety of pathogens can enter the fetal gastrointestinal tract. (This is why it is so important to examine expectant mother for the presence of infections.)
First hours. Microorganisms that enter the child’s mouth are swallowed and, upon entering the stomach, are partially inactivated by the action of hydrochloric acid, which is part of the gastric juice. However, if microbes enter the child’s body in large quantities, if they have protective factors(shells insoluble in hydrochloric acid) or are in lumps of mucus from the genital tract (mucus also protects microorganisms from the action of acid), some of them still reach the intestines and begin their colonization (reproduction) there. The environment for the proliferation of microbes is food, which by that time begins to enter the intestines.
First days. As a rule, E. coli dominates among the first microorganisms to colonize the intestines of a newborn. This is a representative of the normal intestinal microflora and makes up 96% of it aerobic component (aerobic microorganisms are those whose vital activity requires oxygen). Escherichia coli has high lactase activity, that is, the ability to ferment milk, and therefore is an important participant in the intestinal enzyme system.
The more actively E. coli colonizes the intestines, the smaller the ecological niche it leaves for pathogenic microorganisms. She will have enough such “competitors”: the hands of the mother and staff, nipples, mother’s breasts, the air of the maternity hospital, instruments - all this contains a diverse and not always harmless flora.
On days 5-7, aerobic microorganisms, multiplying using oxygen, deplete the intestinal environment with it. That's when expansion begins anaerobic(not requiring oxygen) component of microflora. It is mainly represented by microbes that are essential for enzymatic activity, such as lacto- and bifidobacteria 1 , there are also small numbers of other bacteria.
Anaerobes enter the baby’s gastrointestinal tract with milk (a large number of them are found in the milk ducts of women). They are practically not found in the environment, since they survive only in the absence of oxygen.
First month. Thus, from 5-7 days of a child’s life, up to 16 types of different microorganisms can be found in his intestines. While populating the intestines, they constantly compete with each other. This temporary instability in the composition of the microflora leads to the so-called physiological dysbacteriosis, which lasts 3-4 weeks in a healthy child and does not require correction. The stool becomes liquefied, mixed with whitish lumps, and quickened (pediatricians call it “transitional”).
At the end of this period, the normal composition of the microflora is established, in which the leading positions will be taken by E. coli, bifidobacteria and lactobacilli, and only 4-6% will be made up of opportunistic (that is, in normal quantities not dangerous) bacteria such as diphtheroids, bacteroides , staphylococcus, proteus and others.

INTESTINAL BIOCENOSIS AND TYPE OF FEEDING

Breastfeeding is a unique natural mechanism for the formation of the intestinal microbial community. Only with mother's milk does lactobacilli and bifidobacteria enter the baby's body.
During artificial feeding, the main microbiological background is represented only by Escherichia coli. In this case, firstly, lactase deficiency may develop, since lacto- and bifidobacteria are important producers of lactase, an enzyme that breaks down milk sugar. Secondly, the competitiveness of normal microflora decreases, which causes reduced resistance to intestinal infections. Therefore, in children who are bottle-fed, prevention of biocenosis disorders must be carried out.

DISORDERS OF INTESTINAL BIOCENOSIS

The following symptoms suggest a violation of the intestinal biocenosis:
Intestinal colic. It usually occurs in the first 4 months of life. Represents paroxysmal pain in the stomach, usually starting in the evening and accompanied by rumbling intestines and a sharp cry of the child. After bowel movements or passing gas, the pain usually goes away. Intestinal colic is most often associated with a lack of microbes that produce lactase.
Intestinal motility disorders: constipation 2 , diarrhea 3 (diarrhea); frequent regurgitation.
Poor or at the lower limit of normal weight gain, disharmonious development.
In recent years, the complex of these manifestations has received the name syndrome of functional disorders of the gastrointestinal tract in children 1 year of life.
However, microflora disturbances can be caused not only by functional disorders, but also intestinal infection: this can be rotavirus, staphylococcal, salmonella enterocolitis, as well as colienteritis caused by pathogenic strains (varieties) of Escherichia coli. In this case, the above symptoms are accompanied by temperature reaction, vomiting, impaired sucking and pathological changes in the nature of the stool (green, lumps, mucus and blood, change in odor).

PREVENTION, CORRECTION AND TREATMENT OF DISORDERS

The first postulate for the prevention of biocenosis disturbances is Continue breastfeeding children until at least 6 months.
If breastfeeding is not possible, then the child's food should be enriched with so-called prebiotics- components that promote the proliferation of bifidobacteria and lactobacilli.
In addition, a large number of mixtures are now produced that contain lacto- and bifidobacteria themselves, for example the domestic mixture “ Agusha " (However, defining the mode artificial feeding, it is necessary to take into account that “Agusha” is only a partially adapted mixture, i.e. contains a large amount of protein and therefore creates a load on the child’s liver, kidneys and intestinal enzyme systems.)
Imported mixtures, created in accordance with the latest recommendations of foreign nutritionists (nutrition specialists), contain less protein. Fermented milk mixture " NAS ", enriched with bifidobacteria and lactobacilli, is recommended for children from the first days of life. A fresh mixture is also available " NAS from 6 to 12 » with bifidobacteria and enterococci (other important lactase producers). The protein content in it is adapted to the needs of a child in the second half of life. You can also mention the mixture " Lactofidus ", containing bifidobacteria and lactobacilli, as well as "ready" lactase. The biological products “Bifidumbacterin”, “Lactobacterin”, as well as the combined product “Linex” are also highly effective.
For frequent regurgitation, mixtures containing carob extracts are recommended, for example “ Frisov "(made from whey, recommended for children prone to constipation) or " Nutrilon-antireflux "(casein-based, indicated for those prone to diarrhea), or starch-containing mixtures (Lemolak).
Kefir, which was widely used in the past, is currently recommended only for feeding children over 8 months, since in younger children it creates a significant burden on all body systems. From 10-12 months, a child can be given yoghurts without added fruit, sugar or flavorings.

If, despite the right approach to your child’s nutrition, if you suspect he has a biocenosis disorder, you should contact your pediatrician. Don't be surprised if the doctor's first question is your own diet and lifestyle. If you eat a lot of foods, causing fermentation(brown bread, grapes, legumes, sugar, kvass, fatty dairy products), and at the same time you are breastfeeding, it is quite possible that this is the cause of bloating and colic in your child. In addition to changing the mother's diet, the doctor may recommend warm, soothing baths for the baby, music therapy, and aromatherapy.
If these methods do not help, the doctor will prescribe drugs that reduce gas formation in the intestines (for example, espumizan-40, meteospasmil), as well as drugs that regulate intestinal motility (selected strictly individually).
And only if severe lactase deficiency is detected, the doctor prescribes appropriate drugs for its treatment, for example lactase solution, simply lactase, lactrase ( nutritional supplements containing the enzyme lactase).

And, probably, it’s worth repeating once again - although only a doctor diagnoses and prescribes treatment, this does not mean that parents are assigned only a passive role in the fight against disorders of the intestinal biocenosis. It is up to you to properly organize the feeding of the child and the nutrition of the mother - and this is the main thing in the prevention of violations of this kind; and only your constant attention to the child, allowing you to notice any changes in his behavior, is all alarming symptoms, will allow for timely identification of violations and timely initiation of their correction and treatment.